title: Dalfampridine improves walking speed, walking endurance, and community participation in veterans with multiple sclerosis: a longitudinal cohort study.
abstract: BACKGROUND
  In short-term trials, dalfampridine extended release (ER) improves walking in people with multiple sclerosis (MS). The tolerability and effects of dalfampridine-ER in clinical practice have not been reported.
  
  
  OBJECTIVE
  The objective of this paper is to determine the clinical tolerability and effects of dalfampridine on walking and community participation.
  
  
  METHODS
  All patients at the Portland VA Medical Center prescribed dalfampridine-ER over one year completed the Timed 25-Foot Walk (T25FW), Multiple Sclerosis Walking Scale-12 (MSWS-12), Two-Minute Timed Walk (2MTW), and Community Integration Questionnaire (CIQ) at baseline and follow-up clinic visits. Ongoing use and measures over one year were analyzed.
  
  
  RESULTS
  A total of 39 patients (mean age 56.5 years, mean disease duration 19.5 years, 82% male, 38% relapsing-remitting MS, 62% progressive MS) were prescribed dalfampridine-ER. Twenty-four (62%) continued to take dalfampridine-ER. At initial follow-up, all measures improved significantly from baseline (T25FW: -2.7 s, p = 0.004; 2MTW: 41 feet (ft), p = 0.002; MSWS12: -11, p < 0.001; CIQ: 1.2, p = 0.003). At one year, walking endurance and self-perceived walking were still significantly improved (2MTW: 33 ft, p = 0.03; MSWS-12: 5.9, p = 0.007).
  
  
  CONCLUSIONS
  Dalfampridine-ER was associated with short-term improvements in walking speed and community participation, and sustained improvements in walking endurance and self-perceived impact of MS on walking for one year. Our study supports the utility of this medication in late MS.
authors.affiliation: Oregon Health and Science University and Portland VA Medical Center, USA.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Cameron
authors.forename: Mary
authors.initials: M
authors.lastname: Fitzpatrick
authors.forename: Shannon
authors.initials: S
authors.lastname: Overs
authors.forename: Charles
authors.initials: C
authors.lastname: Murchison
authors.forename: Jane
authors.initials: J
authors.lastname: Manning
authors.forename: Ruth
authors.initials: R
authors.lastname: Whitham
mesh_terms: D015761:4-Aminopyridine / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003256:Community Participation; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D026902:Potassium Channel Blockers / Q000627:therapeutic use*; D014728:Veterans; D016138:Walking / Q000502:physiology*
chemical_list: D026902:Potassium Channel Blockers; D015761:4-Aminopyridine
keywords: Multiple sclerosis; cohort studies; cost effectiveness/economic; dalfampridine; walking